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Home My WebLink AboutBuilding Permit # 3/28/2016 BUIL %AORTHDING PERMIT 0 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION PermftNo# Date Received"17 0"A-rw f-v T ITS US Date Issued: zE-�)i IMPORTANT: Applicant must complete all items on this page LOCATION 040 Print PROPERTY OWNER el � TPi OSI - IN Print 100 Year Structure Eye nno s C, y MAP PARCEL&2] ZONING DISTRICT:--Historic District yes; Machine Shop Village yes no TYPE OF IMPROVEMENT --PROPOSED USE Residential Non- Residential El New Building El One family 0 Mclition El Two or more family El Industrial RrAlteration No. of units: ommercial PIPpair, replacement El Assessory Bldg El Others: RMemolition El Other Qe-P.4.ex roq e "y DESCRIPTION OF ORK TO BE PERFORMED: ,, 1/44%0 C 4 G4ff;z;`4 6 ilu &:qee*r,% A cews w:J (exfeee.@D 6t,1145. 9,K&--r- Lots y eoTxy I>oe>as 15�ec. entification- Please Type or Print Clearly,, OWNER: Name: 41gJe #?&"f —IPQ&f: eK4-4o&,ee Phone:17;�26- 647-s?a� Address: a-?& (PF-F,'co i7-7SA 4w Pq fa?-Ai - -Pao Ke'll"'He Contractor Name:Seqi4oi:,j C- o-(D Phone: SSR 30 Email: Vtgeoin-,,/e Ad( Supervisor's Construction License: C5 07,�rg&d, —Exp. Date: /,;t/f b4, Home Improvement License: Exp. Date: ARCHITECT/ENGINEERX,b. LAW&se- Phone: Address:/ 1��W Mleez � �,i,400ee, W,4 T/Y/0_Reg. No. FEE SCHEDULE.BULDING PERMIT.'$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 1,93� &001 FEE: $ Check No.: Receipt No.:-61`1 g�Yh NO,rE: 1, nr�egisAirerxi .Xers,ons con ac w t I contractors do not have ac stoth uaranty fund np'.r Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swiinu�ing Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Permanent Durapster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF A U FORM IkLANNING DEVELOPMENT Reviewed On 3 I ZY0C Signature_ v MENTS— A)A, CONSERVATION Reviewed on Signature COMMENTS y...,. `! '-,'T""I^./� - ` S„,/ I `...r'^-,� �.,.! �.._... la.,.j�l. a� 4,.,./)w.. 4 ••`.-^.` ....1 A�.. (.;�...-11,,,x\ �„✓'4.,... r) J HEALTH Revie ed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer Connection/Sic�natuwo� gate Driveway Permit DPW Town.Engineer: Signature: Located 384 Osgood Street FIRE'1DEP,ARTiA11ENT C . Temp Dumpster on site yes no Loatedat 124s M ain Street e Firs me "t, sig`�aa�ure/dale COMMENTS ' F N®RTH i own of 111dover 0 ..... 0 ® _ . "&` * t 4!�h s h ver rl'+ i� s�1 O LAKE ' SA�/�' CCICKICHIWICK �,9 A°RATEDP S V BOARD OF HEALTH F= R LD Food/Kitchen Septic System itTHIS CERTIFIES THAT ............... . .... ................. BUILDING INSPECTOR .. ...................... ......... .. ......... .........%4 .. .......... 3 has permission to erect buildings on .. ...... Foundation % Rough Ao^b to be occupied as ......... .. ...... . ........ a-t . ..... .. ....... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the ap cation Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Altera 'on and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final EXPIRESPERMIT MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI STARTS Rough .�. Service .............. .yam. . .. tom-............................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Consicuo s Place on the Premises — Do Not Remove Final No Lathingor Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. Initial Construction Control Document M To be submitted with the building permit application by a H Registered Design Professional a �< for work per the 81h edition of the Massachusetts State Building Code, 780 CMR, Section 107 M SYO Project Title: Grange Hall Tenant Fit-Out Phase 1 Date: 24 March 2016 Property Address: 3 Great Pond Road,North Andover,MA 01845 Project: Check(x)one or both as applicable: _New construction X Existing Construction Project description: This submittal is for the first phase of an interior fit-out of an existing two story"Grange Hall" A phase two submittal is anticipated at a later date to integrate specific tenant needs. I Joseph D.LaGrasse,AIA MA Registration Number: 4153 Expiration date: 08/31/2016 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning': X Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge,information,and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I(or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review,for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports (see item 3.)together with pertinent comments, in a form acceptable to the building official ,-,p ARCy Upon completion of the work,I shall submit to the building official a `Final Cocument'. Enter in the space to the right a"wet"or 053 electronic signature and seal: oIOU � A DMA R' ri 5 C��FAL H OF MPS� Phone number: 978.470.3675 Email:jlagrasse@lagrassear ects.com Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised.If`other'is chosen, provide a description. Version 06 11 2013 Massachusetts -Departiment of Public Safety Board of Building Regulations and Standards a.uTiitt ttt.ttuii aul��t c ts0i �, � License: GS-075302 BENJAMIN C 69 Old Village Lade ' North Andover WFA 018 5; ; x Expiration Commissioners 12/04/2016 NOTICE N W NOTICE 4 u 0 TO EMPLOYEES EMPLOYEES e � The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL 1 Congress Street, Suite 100, Boston, Massachusetts 02114 — 2017 617-7274900 ® http://www.state.-.na.tis/dia As required by Massachusetts General Law, Chapter 152,Sections 21,22&30, this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by ensuring with: ACE GROUP NAME OF INSURANCE COMPANY P .O. BOX 1 450 MA 02344-1450 ADDRESS OF INSURANCE COMPANY (6562UB-OG23626-9-15) 08-15-15 TO os-is-16 POLICY NUMBER EFFECTIVE DA'Z'ES M P ROBERTS INS AGENCY 1060 OSGODD STREET NORTH ANDOVER MA 01845 NAME OF INSURANCE AGENT ADDRESS PHONE # _ OLD SALEM VILLAGE OF NORTH HEPATICA DRIVE & ANDOVER CONDOMINIUM TRUST: MAYFLOWER DRIVE ® NORTH ANDOVER MA 01845 — EMPLOYER ADDRESS EiMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE m- MEDICAL The above famed insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the ° - injured employee. The employee may select his or her own physician. The reasonable cost of the services a provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS alters W20P1G16 L � _